Effort-reward imbalance and common mental disorders among firefighters

Angelin, Alexandre Sérgio de Oliveira; Lucca, Sérgio Roberto de

doi:10.47626/1679-4435-2026-1638

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ORIGINAL ARTICLE • Rev. Bras. Med. Trab. 24 • 2026 • https://doi.org/10.47626/1679-4435-2026-1638 linkcopy

Effort-reward imbalance and common mental disorders among firefighters

Authorship SCIMAGO INSTITUTIONS RANKINGS

Introduction: Occupational stress and psychosocial factors at work are recognized as triggers of psychological distress, musculoskeletal disorders, and decreased functional capacity in the contemporary workplace.

Objectives: This study investigated effort-reward imbalance and common mental disorders among 372 firefighters working in Brazil.

Methods: This was a cross-sectional study conducted with a sample of 372 firefighters using a log-binomial regression model.

Results: The prevalence of common mental disorders was 9.7% in the total sample and reached 10.7% in the high-risk group (effort-reward imbalance ratio > 1). Log-binomial regression showed that the effort-reward imbalance model increased the explanatory power of mental distress to 12.1%. High effort was associated with an increased risk of common mental disorders (prevalence ratio = 2.21), whereas overcommitment had the greatest impact on prevalence (prevalence ratio = 2.41). Effort was also the main predictor of symptom severity (β = 0.443; p < 0.001).

Conclusions: These findings indicate that effort-reward imbalance constitutes an important marker of psychosocial risk among firefighters. The population attributable fraction for overcommitment was 51.1%, indicating that more than half of common mental disorder cases may be attributed to this dimension. Thus, occupational demands and perceived recognition emerged as key determinants of mental health in this professional category. The study reinforces the need for mental health surveillance and promotion strategies that consider the specific characteristics of firefighters’ military operational environment.

Keywords
firefighters; occupational stress; occupational health; mental health

Variables	ERI				Effort				Reward				Overcommitment				Prevalence of CMD
Variables	At risk		Not at risk		High		Low		High		Low		High		Low		Prevalence of CMD
Total (n = 372)	(n)	(%)	(n)	(%)	(n)	(%)	(n)	(%)	(n)	(%)	(n)	(%)	(n)	(%)	(n)	(%)	(n)	(%)
Age group, years	164	44.09	208	55.91	183	49.20	189	50.80	199	53.50	173	46.50	166	44.60	206	55.40	36	9.70
18-24		16.70		83.30		20.00		80.00		45.00		55.00		10.00		90.00		0.00
25-34		44.60		55.40		56.80		43.20		45.30		54.70		48.40		51.60		6.30
35-44		42.00		58.00		53.10		46.90		58.70		41.30		49.70		50.30		15.40
45-54		44.30		55.70		42.60		57.40		56.40		43.60		43.60		56.40		7.90
55-64		33.30		66.70		46.20		53.80		46.20		53.80		23.10		76.90		0.00
> 65		0.00		0.00		0.00		0.00		53.50		46.50		0.00		55.40		0.00
Sex
Female		51.20		48.80		50.00		50.00		34.10		65.90		36.40		63.60		22.40
Male		40.70		59.30		49.40		50.60		55.80		44.20		45.40		54.60		8.00
Not reported		0.00		100		0.00		100		100		00.00		100		0.00		0.00
Self-reported race/skin color
White		39.30		60.70		46.90		53.01		54.90		45.10		41.40		58.60		9.50
Asian		66.70		33.30		66.70		33.30		50.00		50.00		83.30		16.70		16.70
Brown		46.50		53.50		54.10		45.90		52.70		47.30		48.60		51.40		9.50
Indigenous		0.00		100		0.00		100		100		0.00		100		0.00		0.00
Black		52.90		47.10		61.10		38.90		33.30		66.70		61.10		38.90		11.10
Prefer not to disclose		0.00		0.00		0.00		0.00		0.00		0.00		0.00		0.00		0.00
Marital status
Single		37.00		63.00		44.70		55.30		50.60		49.40		42.40		57.60		9.40
Married/Stable union		41.10		58.90		49.40		50.60		53.70		46.30		44.40		55.60		10.40
Divorced/Separated		60.70		39.30		60.70		39.30		60.70		39.30		53.60		46.40		3.60
Widowed		0.00		0.00		0.00		0.00		0.00		0.00		0.00		0.00		0.00
Educational attainment
Completed secondary education		38.30		61.70		41.10		58.90		46.70		53.30		36.70		63.30		11.10
Completed technical education		36.80		63.20		47.40		52.60		50.00		50.00		52.60		47.40		10.50
Completed higher education		39.70		60.30		48.80		51.20		60.30		39.70		43.80		56.20		11.60
Incomplete higher education		46.70		53.30		52.20		47.80		47.80		52.20		41.30		58.70		0.00
Lato sensu graduate degree (specialization)		49.30		50.70		58.90		41.10		56.20		43.80		54.80		45.20		11.00
Stricto sensu graduate degree (Master’s)		25.00		75.00		50.00		50.00		50.00		50.00		25.00		75.00		0.00
Stricto sensu graduate degree (Doctorate)		0.00		0.00		0.00		0.00		0.00		0.00		0.00		0.00		0.00
Rank
Private		37.80		62.20		46.70		53.30		53.30		46.70		39.00		61.00		8.60
Corporal		47.10		52.90		44.40		55.60		47.20		52.80		47.20		52.80		13.40
Sergeant		41.40		58.60		55.40		44.60		63.00		37.00		43.50		56.50		4.30
Warrant Officer		58.30		41.70		69.20		30.80		61.50		38.50		46.20		53.80		7.70
Officer Cadet/Officer Trainee		0.00		0.00		0.00		0.00		0.00		0.00		0.00		0.00		25.00
Lieutenant		0.00		100		75.00		25.00		100		0.00		75.00		25.00		10.00
Captain		30.00		70.00		50.00		50.00		20.00		80.00		60.00		40.00		0.00
Major		0.00		0.00		0.00		0.00		0.00		0.00		0.00		0.00		0.00
Colonel/Lieutenant Colonel		0.00		100		0.00		0.00		0.00		100		0.00		100		0.00
Duty status
Administrative		36.20		63.80		44.30		55.70		55.70		44.30		41.00		59.00		7.40
Operational		44.80		55.20		52.20		47.80		52.20		47.80		46.20		53.80		10.10
Removed from operational duties		0.00		100		0.00		100		66.70		33.30		66.70		33.30		66.70
Operational unit
7th FB		32.60		67.40		51.70		48.30		61.80		38.20		40.40		59.60		6.70
15th FB		43.80		56.30		52.90		47.10		62.70		37.30		43.10		56.90		25.50
16th FB		50.50		49.50		43.60		56.40		46.50		53.50		46.50		53.50		0.00
19th FB		36.80		63.20		35.00		65.00		40.00		60.00		50.00		50.00		15.00
CBI-1		43.80		56.30		40.00		60.00		55.00		45.00		35.00		65.00		0.00
CCB		40.40		59.60		56.00		44.00		50.50		49.50		48.40		51.60		15.40

Independent variables	Model 1 (ERI) PR (95%CI)	Model 2 (ERI + overcommitment) PR (95%CI)	Model 3 (adjusted*) PR (95%CI)
Overcommitment
Low (Ref.)	1.00	1.00	1.00
High	—	2.65 (1.18-5.95)*	2.41 (1.09-5.34)*
Effort
Low (Ref.)	1.00	1.00	1.00
High	2.19 (1.16-4.14)*	1.31 (0.63-2.73)	2.21 (0.93-5.23)
Reward
High (Ref.)	1.00	1.00	1.00
Low	1.19 (0.60-2.35)	0.85 (0.41-1.75)	1.19 (0.65-2.17)
Sex
Male (Ref.)	—	—	1.00
Female	—	—	3.77 (1.85-7.69)†
Goodness of fit
AICc	169.86	165.83	159.76

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[1] AICc = corrected Akaike information criterion; CMD = common mental disorders; ERI = effort-reward imbalance; PR = prevalence ratio; Ref. = reference category; SRQ-20 = Self-Reporting Questionnaire-20.

[2] The normality of continuous variables was assessed using the Kolmogorov-Smirnov test.

[3] Model 3 adjusted for age group, sex, and unit/major command.

[4] Log-binomial regression was used to estimate the PRs for the dichotomous outcome CMD (SRQ-20 ≥ 7). The adjusted model showed the best fit (AICc = 159.76).

[TN3] ^*
p < 0.05

[TN4] ^†
p < 0.001